DOP104 International differences in pre-operative characteristics and postoperative management in patients with Crohn’s disease following ileocolic resection: a report from the IMPACT consortium
Bibliographic record
Abstract
Abstract Background Intestinal surgery is a key treatment for Crohn’s disease (CD). Large cohort data on perioperative management are vital to improve postoperative outcomes. This study aimed to assess and compare preoperative characteristics and postoperative management across three large prospective cohort studies of CD patients following ileocolic resection (ICR). Methods The IMPACT consortium (International Multidisciplinary Research Collaboration on Postoperative IBD) is an intercontinental initiative focused on postoperative inflammatory bowel disease research. Prospective data were used from three ongoing cohort studies with a comparable set-up and data collection, including CD patients who underwent ICR between December 2009 and September 2024, originating from the Netherlands (NL), North-America (Canada [CAN] and United States of America [USA]) and France (FR). Pre-operative characteristics, clinical risk profiles for post-operative recurrence (POR), use of postoperative prophylactic medication and performance of endoscopic evaluation were compared between the involved countries. Results 1,601 patients with CD following ICR were included (455 NL, 149 CAN, 307 USA, 690 FR)(48.3% male; median age at surgery 33.7 years [IQR 25.8-46.6])(Table 1). Active smoking rates were higher in Europe (NL: 26.2%; FR: 32.8%) compared with North America (CAN: 13.2%; USA: 8.2%). Prior small bowel resections were more common in North American (CAN: 29.5%; USA: 27.0%) compared with Europe (NL: 20.0%; FR: 17.0%). Preoperative biological exposure was lower in Canada (55.7%) and the USA (56.0%) compared with the Netherlands (69.2%) and France (75.5%). A higher proportion of Dutch patients had non-complicated CD (Montreal B1) at surgery (18.4%) compared to other countries (CAN: 1.4%; USA: 2.3%; FR: 4.5%). Overall, 72.7% were considered high-risk for POR, with the lowest rates in the Dutch cohort (62.2%) compared to the other countries (CAN: 73.8%; USA: 77.9%; FR: 77.1%). Postoperative prophylactic medication was initiated in 42.2% with higher rates in the USA (45.9%) and France (51.0%) compared with the Netherlands (28.5%) and Canada (34.9%). Details on postoperative prophylactic medication use are provided in Table 2. An endoscopic evaluation within one year postoperatively was performed in 89.0% of patients, with higher rates (>85%) in the Netherlands, Canada, and France, compared with the USA (66.9%). Conclusion This first study of the IMPACT consortium revealed notable differences in preoperative characteristics, risk profiles for postoperative recurrence, use of prophylactic medication, and postoperative endoscopic evaluation across Europe and North America. Further analyses will include the assessment of rates and factors associated with endoscopic recurrence. References 1.Gionchetti P, Dignass A, Danese S, et al. ; ECCO . 3rd European evidence-based consensus on the diagnosis and management of Crohn’s disease 2016: Part 2: surgical management and special situations. J Crohns Colitis. 2017;11:135–149 2.Lamb CA, Kennedy NA, Raine T, et al. British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults. Gut. 2019;68:s1–s106.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.002 | 0.003 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".